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Clinical characteristics and course of primary brain abscess

  • Original Article - Infection
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Due to improved diagnostic methods, the incidence of brain abscess is still rising. Therefore, clear and evidence-based therapy for the patients who suffer from brain abscesses is necessary. Brain abscesses are potentially life-threatening conditions that possibly lead to permanent injuries even after sufficient healing has taken place. The aims of this study were to analyze the clinical aspects of patients with brain abscesses and thereby to reveal the relevant aspects for the future treatment of the brain lesions.

Methods

We retrospectively identified 47 patients (24 male, 23 female) who had received surgery or undergone the frameless stereotactic drainage of brain abscesses in our center from March 2009 to May 2017. We analyzed the clinical characteristics of the patients, as well as comorbidities and outcomes.

Results

The mean age was 58 (range 7 to 86). Focus identification was successful in 28 patients (60%), with the most frequent causes of brain abscesses including the following: sinusitis (25%), dental infections (25%), and mastoiditis (21%). The mean Charlson Comorbidity Index was 1.57. Among the patients, 34% showed immunosuppressive conditions. We performed 1.5 surgeries per patient (53% via craniotomy, 28% biopsies or stereotactic drainage, 19% both procedures), followed by antibiotic treatment for 6.5 weeks (mean). In 30% of patients, no bacteria could be isolated. During the follow-up period (a median of 12 months), 23.4% of the patients died. The mortality rate during the initial hospital stay was 4.3%.

Conclusion

One third of the patients with brain abscesses showed immunosuppressive conditions, whereas brain abscesses also often occur in patients with good medical conditions. The isolation of the focus of infection is often possible. Surgical procedures showed very good outcomes. Patients over 60 years showed significantly worse clinical outcomes.

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Authors and Affiliations

  1. Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Nicole Lange, Ann-Kathrin Jörger, Arthur Wagner, Yu-Mi Ryang, Bernhard Meyer & Jens Gempt

  2. Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Nicole Lange

  3. Neuroradiological Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Maria Berndt & Nina Lummel

  4. Microbiological Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Nina Wantia

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  1. Nicole Lange
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Correspondence to Nicole Lange.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required.

Additional information

Data previously presented on EANS Congress (2017, Venice) as a lecture.

This article is part of the Topical Collection on Infection

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Lange, N., Berndt, M., Jörger, AK. et al. Clinical characteristics and course of primary brain abscess. Acta Neurochir 160, 2055–2062 (2018). https://doi.org/10.1007/s00701-018-3633-6

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  • DOI: https://doi.org/10.1007/s00701-018-3633-6

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